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INTERNATIONAL JOURNAL OF BEHAVIORAL CONSULTATION AND THERAPY ©2012, ALL RIGHTS RESERVED 2012, VOL. 7, NO. 2–3 ISSN: 1555–7855 Therapists’ Attitudes about and Preferences to Use Relationship Focused Interventions: New Tools to Measure a Critical Component of Functional Analytic Psychotherapy (FAP) Christeine M. Terry & Robert J. Kohlenberg University of Washington Abstract The primary study aims were to create reliable measures of therapists’ attitudes about and preferences to use Relationship Fo- (cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:9)(cid:10)(cid:5)(cid:11)(cid:12)(cid:5)(cid:9)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:15)(cid:16)(cid:17)(cid:8)(cid:4)(cid:18)(cid:19)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:13)(cid:9)(cid:12)(cid:5)(cid:4)(cid:10)(cid:13)(cid:21)(cid:20)(cid:10)(cid:5)(cid:7)(cid:22)(cid:20)(cid:2)(cid:10)(cid:14)(cid:11)(cid:4)(cid:7)(cid:10)(cid:23)(cid:20)(cid:10)(cid:7)(cid:13)(cid:9)(cid:24)(cid:3)(cid:5)(cid:9)(cid:2)(cid:5)(cid:7)(cid:10)(cid:23)(cid:5)(cid:25)(cid:26)(cid:7)(cid:27)(cid:28)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:13)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)(cid:25)(cid:5)(cid:20)(cid:4)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)(cid:14)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:11)(cid:20)(cid:29)(cid:13)(cid:4)(cid:10)(cid:4)(cid:31)(cid:7)(cid:20)(cid:10)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:4)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7) (cid:29)(cid:11)(cid:5)(cid:22)(cid:5)(cid:11)(cid:5)(cid:9)(cid:2)(cid:5)(cid:4)(cid:7)!(cid:5)(cid:11)(cid:5)(cid:7)(cid:20)(cid:6)(cid:25)(cid:13)(cid:9)(cid:13)(cid:4)(cid:10)(cid:5)(cid:11)(cid:5)(cid:6)(cid:7)(cid:10)(cid:14)(cid:7)(cid:20)(cid:7)(cid:9)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:20)(cid:30)(cid:7)(cid:4)(cid:20)(cid:25)(cid:29)(cid:30)(cid:5)(cid:7)(cid:14)(cid:22)(cid:7)(cid:25)(cid:5)(cid:9)(cid:10)(cid:20)(cid:30)(cid:7)(cid:23)(cid:5)(cid:20)(cid:30)(cid:10)(cid:23)(cid:7)(cid:10)(cid:11)(cid:20)(cid:13)(cid:9)(cid:5)(cid:5)(cid:4)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:17)"#(cid:7)(cid:29)(cid:11)(cid:20)(cid:2)(cid:10)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:5)(cid:11)(cid:4)(cid:26)(cid:7)$(cid:23)(cid:5)(cid:7)(cid:25)(cid:5)(cid:20)(cid:4)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)(cid:6)(cid:5)(cid:25)(cid:14)(cid:9)(cid:4)(cid:10)(cid:11)(cid:20)(cid:10)(cid:5)(cid:6)(cid:7) acceptable reliability ((cid:2)(cid:31)(cid:4)(cid:7)%(cid:7)(cid:26)&’(cid:18)(cid:26)(cid:7)(cid:17)"#(cid:7)(cid:29)(cid:11)(cid:20)(cid:2)(cid:10)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:5)(cid:11)(cid:4)(cid:7)(cid:11)(cid:5)(cid:29)(cid:14)(cid:11)(cid:10)(cid:5)(cid:6)(cid:7)(cid:25)(cid:14)(cid:11)(cid:5)(cid:7)(cid:29)(cid:14)(cid:4)(cid:13)(cid:10)(cid:13)(cid:12)(cid:5)(cid:7)(cid:5)(cid:28)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:13)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)(cid:20)(cid:10)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:4)(cid:7)(cid:20))(cid:14)(cid:3)(cid:10)(cid:7)(cid:16)(cid:17)(cid:8)(cid:4)(cid:7)(cid:10)(cid:23)(cid:20)(cid:9)(cid:7)(cid:10)(cid:11)(cid:20)(cid:13)(cid:9)(cid:5)(cid:5)(cid:4)(cid:7)(cid:15)(cid:29)(cid:7) %(cid:7)(cid:26)’*(cid:18)(cid:26)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)(cid:7)(cid:6)(cid:13)(cid:20)(cid:21)(cid:9)(cid:14)(cid:4)(cid:13)(cid:4)(cid:7)(cid:6)(cid:13)(cid:6)(cid:7)(cid:9)(cid:14)(cid:10)(cid:7)(cid:20)(cid:29)(cid:29)(cid:5)(cid:20)(cid:11)(cid:7)(cid:10)(cid:14)(cid:7)(cid:13)(cid:9)(cid:24)(cid:3)(cid:5)(cid:9)(cid:2)(cid:5)(cid:7)(cid:29)(cid:11)(cid:20)(cid:2)(cid:10)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:5)(cid:11)(cid:4)(cid:31)(cid:7)(cid:29)(cid:11)(cid:5)(cid:22)(cid:5)(cid:11)(cid:5)(cid:9)(cid:2)(cid:5)(cid:4)(cid:7)(cid:10)(cid:14)(cid:7)(cid:3)(cid:4)(cid:5)(cid:7)(cid:16)(cid:17)(cid:8)(cid:4)(cid:7)(cid:15)(cid:29)(cid:7),(cid:7)(cid:26)’*(cid:18)(cid:26)(cid:7)$(cid:23)(cid:5)(cid:11)(cid:20)(cid:29)(cid:13)(cid:4)(cid:10)(cid:7)(cid:10)(cid:11)(cid:20)(cid:13)(cid:9)(cid:13)(cid:9)(cid:21)(cid:7)(cid:25)(cid:20).(cid:7)(cid:20)(cid:22)(cid:22)(cid:5)(cid:2)(cid:10)(cid:7) (cid:29)(cid:11)(cid:5)(cid:22)(cid:5)(cid:11)(cid:5)(cid:9)(cid:2)(cid:5)(cid:4)(cid:7)(cid:10)(cid:14)(cid:7)(cid:3)(cid:4)(cid:5)(cid:7)(cid:16)(cid:17)(cid:8)(cid:4)(cid:26) Keywords Functional Analytic Psychotherapy, Therapeutic Relationship, Measures to Assess Therapeutic Relationship, Implicit Measurement of Therapy Processes T he role of the therapeutic relationship is emphasized as an For the purposes of the paper, the term Relationship Focused important factor across several therapies, including newer Interventions (RFIs) will be used in place of in-vivo interven- contextual behavioral therapies such as Functional Analytic tions. The term relationship-focused intervention better cap- Psychotherapy (FAP). FAP exclusively focuses on the use of the tures the role of the therapeutic relationship in FAP. Also, in- therapeutic relationship as a primary mechanism of therapeutic vivo interventions are not unique to FAP and practitioners from change. FAP requires that therapists assess for and consequate other therapies may be more amenable to the term Relationship in-session behaviors that are characteristic of the client’s pre- Focused Interventions. Thus, it may help facilitate research on senting problems and approximations of behaviors related to RFIs by practitioners from other theoretical orientations or ther- their treatment goals. The focus on in-session behavior and the apy approaches. use of behavioral techniques to consequate in-session behaviors Relationship Focused Interventions use the “live” moment- is termed in-vivo (Kohlenberg & Tsai, 1991). In-vivo interven- to-moment interactions between the client and the therapist tions, briefly defined as the use of moment-to-moment therapy (Kanter et al., 2009). Maximal behavior change occurs when a interactions (Kanter et al., 2009), are believed to be potent thera- reinforcer is delivered close in time and location to the behav- peutic interventions because they enable therapeutic change to ior’s occurrence; thus, maximal therapeutic change is thought occur more rapidly or enhance the effectiveness of non-FAP to occur when behaviors are consequated close in time and lo- related techniques (e.g., cognitive disputation) (Baruch et al., cation to the behavior’s occurrence (i.e., in-session behaviors; 2009; Robert J. Kohlenberg, personal communication, March 27, R. J. Kohlenberg, personal communication, March 27, 2007; cf. 2007). Currently, there are no published measures of the factors Baruch et al., 2009 for a detailed examination of the empirical (e.g., beliefs about in-vivo interventions, attitudes about in-vivo literature on basic behavioral principles underlying FAP). Basic interventions) that may promote or inhibit therapists’ use of this behavioral research supports the idea that relationship focused important class of interventions. The current study was a first processes are powerful behavior change strategies and many step toward improving our understanding of the factors related therapies promote the use of these processes (e.g., Beck, Rush, to therapists’ use of in-vivo interventions. Shaw, & Emery, 1979). +(cid:23)(cid:11)(cid:13)(cid:4)(cid:10)(cid:5)(cid:13)(cid:9)(cid:5)(cid:7)$(cid:5)(cid:11)(cid:11).(cid:7)(cid:13)(cid:4)(cid:7)(cid:9)(cid:14)!(cid:7)(cid:20)(cid:10)(cid:7)#(cid:14)(cid:11)(cid:10)(cid:30)(cid:20)(cid:9)(cid:6)(cid:7)#(cid:4).(cid:2)(cid:23)(cid:14)(cid:10)(cid:23)(cid:5)(cid:11)(cid:20)(cid:29).(cid:7)+(cid:30)(cid:13)(cid:9)(cid:13)(cid:2)(cid:19)(cid:7)(cid:16)(cid:5)(cid:4)(cid:5)(cid:20)(cid:11)(cid:2)(cid:23)(cid:19)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)$(cid:11)(cid:20)(cid:13)(cid:9)(cid:13)(cid:9)(cid:21)(cid:7)+(cid:5)(cid:9)(cid:10)(cid:5)(cid:11)(cid:7) Several empirical studies suggest that RFIs are unique to (cid:13)(cid:9)(cid:7)#(cid:14)(cid:11)(cid:10)(cid:30)(cid:20)(cid:9)(cid:6)(cid:19)(cid:7)0(cid:16)(cid:26) interpersonally-focused therapies and that their addition may $(cid:23)(cid:5)(cid:7)(cid:20)(cid:3)(cid:10)(cid:23)(cid:14)(cid:11)(cid:4)(cid:7)!(cid:14)(cid:3)(cid:30)(cid:6)(cid:7)(cid:30)(cid:13)1(cid:5)(cid:7)(cid:10)(cid:14)(cid:7)(cid:14)(cid:22)(cid:22)(cid:5)(cid:11)(cid:7)(cid:10)(cid:23)(cid:5)(cid:13)(cid:11)(cid:7)(cid:21)(cid:11)(cid:20)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:7)(cid:10)(cid:14)(cid:7)"(cid:9)(cid:10)(cid:23)(cid:14)(cid:9).(cid:7)2(cid:11)(cid:5)(cid:5)(cid:9)!(cid:20)(cid:30)(cid:6)(cid:19)(cid:7)#(cid:23)(cid:26)3(cid:26)(cid:7)!(cid:23)(cid:14)(cid:7)(cid:21)(cid:5)(cid:9)(cid:5)(cid:11)- improve outcomes. A study of cognitive therapy for depression ously provided his time and assistance in developing and piloting the RFIs IAT and the showed that the occurrence of RFIs was rare (Bolling, Parker, & (cid:4)(cid:10)(cid:3)(cid:6).(cid:7)(cid:29)(cid:11)(cid:14)(cid:2)(cid:5)(cid:6)(cid:3)(cid:11)(cid:5)(cid:4)(cid:26)(cid:7)$(cid:23)(cid:5).(cid:7)(cid:20)(cid:30)(cid:4)(cid:14)(cid:7)!(cid:13)(cid:4)(cid:23)(cid:7)(cid:10)(cid:14)(cid:7)(cid:5)(cid:28)(cid:10)(cid:5)(cid:9)(cid:6)(cid:7)(cid:10)(cid:23)(cid:5)(cid:13)(cid:11)(cid:7)(cid:21)(cid:11)(cid:20)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:7)(cid:10)(cid:14)(cid:7)4(cid:20)(cid:4)(cid:14)(cid:9)(cid:7)5(cid:3)(cid:14)(cid:25)(cid:20)(cid:19)(cid:7)#(cid:23)(cid:26)3(cid:26)(cid:19)(cid:7) Kohlenberg, 2000). This result was replicated in a second study 4(cid:5)(cid:9)(cid:9)(cid:20)(cid:7)5(cid:5)4(cid:5)(cid:3)(cid:9)(cid:5)(cid:19)(cid:7)#(cid:23)(cid:26)3(cid:26)(cid:19)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)6(cid:20)(cid:6)(cid:5)(cid:30)(cid:14)(cid:9)(cid:7)7(cid:14)(cid:30)(cid:30)(cid:13)(cid:9)(cid:21)(cid:19)(cid:7)#(cid:23)(cid:26)3(cid:26)(cid:7)!(cid:23)(cid:14)(cid:7)(cid:29)(cid:11)(cid:14)(cid:12)(cid:13)(cid:6)(cid:5)(cid:6)(cid:7)(cid:22)(cid:5)(cid:5)(cid:6))(cid:20)(cid:2)1(cid:7)(cid:14)(cid:9)(cid:7)(cid:5)(cid:20)(cid:11)(cid:30)(cid:13)(cid:5)(cid:11)(cid:7) that found that the use of RFIs in both behavioral activation and (cid:6)(cid:11)(cid:20)(cid:22)(cid:10)(cid:4)(cid:7)(cid:14)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:29)(cid:20)(cid:29)(cid:5)(cid:11)(cid:26)(cid:7)(cid:8)(cid:9)(cid:7)(cid:29)(cid:20)(cid:11)(cid:10)(cid:13)(cid:2)(cid:3)(cid:30)(cid:20)(cid:11)(cid:19)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)8(cid:11)(cid:4)(cid:10)(cid:7)(cid:20)(cid:3)(cid:10)(cid:23)(cid:14)(cid:11)(cid:7)!(cid:13)(cid:4)(cid:23)(cid:5)(cid:4)(cid:7)(cid:10)(cid:14)(cid:7)(cid:5)(cid:28)(cid:10)(cid:5)(cid:9)(cid:6)(cid:7)(cid:23)(cid:5)(cid:11)(cid:7)(cid:21)(cid:11)(cid:20)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:7)(cid:10)(cid:14)(cid:7)4(cid:20)(cid:4)(cid:14)(cid:9)(cid:7) 5(cid:3)(cid:14)(cid:25)(cid:20)(cid:7)!(cid:23)(cid:14)(cid:4)(cid:5)(cid:7)(cid:21)(cid:3)(cid:13)(cid:6)(cid:20)(cid:9)(cid:2)(cid:5)(cid:19)(cid:7)(cid:20)(cid:4)(cid:7)!(cid:5)(cid:30)(cid:30)(cid:7)(cid:20)(cid:4)(cid:7)(cid:23)(cid:13)(cid:4)(cid:7)(cid:22)(cid:5)(cid:5)(cid:6))(cid:20)(cid:2)1(cid:19)(cid:7)!(cid:20)(cid:4)(cid:7)(cid:13)(cid:25)(cid:25)(cid:5)(cid:9)(cid:4)(cid:5)(cid:30).(cid:7)(cid:23)(cid:5)(cid:30)(cid:29)(cid:22)(cid:3)(cid:30)(cid:7)(cid:13)(cid:9)(cid:7)(cid:11)(cid:5)(cid:12)(cid:13)(cid:4)(cid:13)(cid:9)(cid:21)(cid:7) cognitive therapy was rare (Kanter et al., 2009). A third study (cid:10)(cid:23)(cid:13)(cid:4)(cid:7)(cid:20)(cid:11)(cid:10)(cid:13)(cid:2)(cid:30)(cid:5)(cid:26) (Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002) suggested 138 THERAPISTS’ ATTITUDES ABOUT AND PREFERENCES TO USE RELATIONSHIP FOCUSED INTERVENTIONS 139 that the addition of RFIs to therapies that do not typically in- preferences about RFIs were affected by the diagnostic label of corporate them might increase their efficacy. In this study, in- the client (Major Depression vs. Cocaine Dependence). corporating RFIs into typical cognitive therapy was related to In designing the study, we predicted that mental health care increased satisfaction with social support and increased im- trainees would self-report positive attitudes about RFIs, but provements in outside relationships. Research from Goldfried would display an implicit bias against RFIs. We also predicted and colleagues (Goldfried, Castonguay, Hayes, Drozd, & Shap- that FAP practitioners would report both explicit and implicit iro, 1997; Goldfried, Raue, & Castonguay, 1998; Wiser & Gold- preferences for RFIs. We also examined the effect of client diag- fried, 1998) also supports the idea that RFIs can improve thera- nosis on preference for RFIs. Research has shown that practitio- py outcomes. In a study of expert psychodynamic therapists and ners tend to hold more negative attitudes about substance use cognitive-behavioral therapists, sessions that were identified as than depression (Angermeyer & Dietrich, 2006; Corrigan et al., having an in-session impact on the client and that resulted in 2000). Therapists’ negative attitudes about substance use may client change were found to have more in-session focus than impact the therapist’s preferences about RFIs in that therapists lower clinically significant sessions (Goldfried, Raue, & Caston- may be less willing to invest their emotional resources for clients guay, 1998). they view negatively. Therefore, we predicted that practitioners Currently, there are no published measures of the factors (e.g., who received a client description with the diagnosis of Cocaine beliefs about RFIs, attitudes about RFIs) that may promote or Dependence would display a stronger bias against RFIs than inhibit therapists’ use of this important class of interventions. practitioners who received a client description that involved a However, in order to study this area, reliable and valid measures diagnosis of Major Depression. of therapist preferences are needed. The current study repre- (cid:2) METHODS sents a first step towards understanding the factors related to therapists’ use of Relationship Focused Interventions. PARTICIPANTS The main focus of this study is the use of both explicit and implicit measurement strategies to examine attitudes about and National Sample of Mental Health Care Trainees (MHTs; n = 144). This preferences toward Relationship Focused Interventions. The national sample of mental health care trainees (MHTs) were primary difference between explicit and implicit measures is individuals enrolled in advanced training programs (Masters, that explicit measures rely on experiences available to introspec- Ph.D., and Psy.D. programs) in clinical psychology, counseling tion, while implicit experiences, generally, do not. As implicit psychology, and social work, as well as interns at sites in clinical measurement appears to be less vulnerable to self-presentation psychology, social work, and psychiatry. biases, we elected to create and use an implicit measure of RFIs Mental Health Practitioners with specialized training in RFIs (termed FAP because we believed that practitioners may be prone to present community members, n = 49). FAP community members were re- more favorable attitudes about RFIs or that it may be difficult searchers, therapists, and graduate students who either identi- for practitioners to reflect on their own preferences for these fied their primary focus of research/therapy as FAP, or who had interventions. received training in FAP. We elected to use the Implicit Association Test (IAT), a meth- MEASURES od that has substantial support for its use as a reliable and valid method of assessing implicit experiences (Greenwald, Poehl- Demographics. The demographics questionnaire included ques- man, Uhlmann, & Banaji, 2009; Lane, Banaji, Nosek, & Green- tions focused on participants’ therapy practice (e.g., caseload, wald, 2007). The IAT assesses implicit attitudes via asking par- theoretical orientation) and basic identifying information. ticipants to sort stimuli representative of a concept or attribute Preference for using Relationship Focused Interventions (RFIs) IAT. This and is based on the idea that the sorting task should be easier measure was created for the study to measure a therapist’s pref- when the two concepts that are sorted similarly are strongly as- erence to use RFIs. The RFIs IAT is very similar to the IAT in its sociated than when they are weakly associated (Nosek et al.). structure, but differs in that the participants are sorting stimuli The IAT generally has moderate to high split-half internal about therapeutic situations rather than race, gender, or politi- consistency, high test-retest reliability, and good convergent, cal affiliation. A second difference between the RFIs IAT and discriminant, and predictive validity (Nosek et al., 2007). Fur- IATs that assess socially constructed attitudes (e.g., race) is that thermore, the reliability of the IAT appears to higher than other the RFIs IAT includes the use of a storyboard (the storyboard implicit measures designed to assess the same construct (Nosek is described below) in which the stimuli used in the IAT were et al., 2007). Research also suggests that it is quite difficult to introduced prior to the IAT measure. fake (Kim, 2003; Steffens, 2004) and that the IAT may be a better RFIs Storyboard. The first screen of the storyboard task included: predictor of behavior related to socially sensitive attitudes than 1.) a brief description of the task; 2.) a request that the partici- of behaviors related to attitudes that are not as socially sensitive. pants imagine themselves as the therapists of the fictional cli- THE CURRENT STUDY ents they were about to read about; 3.) a statement that the pic- The study had three aims. The first aim was to create measures tures in the storyboard would be used in later tasks and were of therapist’s RFIs preferences (defined as approaching or avoid- designed to help them remember the client statement associ- ing RFIs opportunities). The second aim was to explore how ated with the picture; 4.) the diagnosis of the clients. Based on FAP training affects participants’ responses on RFIs measures. the participant’s randomization, he/she read a description of the The final aim of the study was to examine whether therapists’ client that varied only in the diagnosis of the client: Major De- 140 TERRY & KOHLENBERG pression, Cocaine Dependence, or no Axis I diagnosis (control Client Y) or attribute (i.e., approach, avoid). In the RFIs IAT, condition). participants were required to sort pictures of the clients from The participants were then presented a picture of Caucasian the RFIs storyboard. Additionally, participants sorted terms female client (gender and race were held constant to reduce belonging to each of the attribute categories (i.e., approach or their effects as confounds) with a statement made by the client avoid; see Figure 3 in the appendix for a schematic of the RFIs directly under the picture (see Figure 1in appendix). The client’s IAT). The critical portions of the IAT are the trials where the name (the names of the clients were “Client X” or “Client Y”) attributes and concepts are assigned to the same key (i.e., com- was displayed above the picture. Eight pictures (4 pictures per bined trials). The differences between the response latencies of client) with their associated client statements were shown to the the combined trials comprise the IAT effect, a measure of rela- participants. tive strength of associations of categories with attributes. Posi- The eight client pictures were taken from Ekman’s Japanese tive scores on the RFIs IAT indicated preferences to use RFIs and Caucasian Facial Expression of Emotions (JACFEE; Mat- relative to avoid RFIs. Negative scores on the RFIs IAT indicated sumoto & Ekman, 1988). All pictures in the JACFEE set have preferences to avoid RFIs relative to approach RFIs. Analyses undergone empirical testing to ensure the validity and reliabil- indicated the RFIs IAT had acceptable internal consistency (α ity of the emotions being displayed in each picture (Matsumoto = .71 for the practice block and α = .77 for the test blocks) and & Ekman, 1988). Based on the content of the four statements were within the range of reliability estimates found in IATs of pictures displaying sadness, anger, and happiness were selected. other implicit experiences (Nosek et al., 2007). To minimize the influence of factors such as the women’s attrac- Therapeutic Relationship Measure (TRM). The TRM was created specif- tiveness we pre-tested the pictures of the Caucasian women in ically for the study to assess explicit attitudes and beliefs about the JACFEE set. Pictures without any identified concerns about RFIs. Participants were asked to rate their level of agreement their use were used in the RFIs storyboard and subsequently, as with using the therapy relationship as a therapeutic technique the stimuli in the RFIs IAT. on a Likert scale from -7 (very negative feelings/strongly dis- Eight statements were created for the study (1 statement per agree) to +7 (very positive feelings about/strongly agree) (0 rep- picture) and were pre-tested for their clarity and face validity. resented a neutral attitude or neither agree/disagree). Based on Four of the statements discussed an important person in the cli- the analyses of the reliability of the TRM one item (a question ent’s life who was not the therapist (termed daily life statements). about the ethics of RFIs) was removed because it did not cor- Client Y always offered daily life statements. The other four relate with the other items on the measure and the removal of statements were identical to the statements about the important the item substantially improved the reliability of the measure. person, but were about the therapist (termed relationship-fo- The internal consistency of the measure was good (α = 0.90). cused statements). Client X always offered relationship-focused The final version of the TRM consisted of 6 items (scored -7 to statements (see Figure 1in the appendix for a storyboard that +7), resulting in a range of total possible scores of -42 to +42 was used in the study)1. The pictures, through their associations with negative scores indicating increasingly negative attitudes with the statements, were believed to be representative of daily and beliefs about RFIs and positive scores indicating increas- life or relationship-focused opportunities. ingly positive attitudes and beliefs about RFIs. Relationship-Focused Interventions (RFIs) IAT. After viewing the story- Explicit RFIs Thermometers. Thermometer measures are typically board, participants completed the RFIs IAT. The RFIs IAT was used in IAT research to assess explicit attitudes. Thermometers designed to assess implicit preferences to approach RFIs relative were created for the study to assess explicit attitudes and prefer- to avoiding RFIs. The pictures from the RFIs storyboard were ences about RFIs interventions. The scales on both thermom- used as the target stimuli and synonyms for approach or avoid eters range from -3 (very coldly/not at all likely to use the thera- were used as the attribute stimuli (see Ostafin, Marlatt, & Gre- peutic relationship) to +3 (very warmly/very likely to use the enwald, 2008 for another study with the same approach/avoid therapeutic relationship) with 0 as the mid-point (neither cold stimuli; see Figures 2 and 3 in the appendix for the stimuli used nor warm/neither unlikely nor likely to use the therapeutic re- in the RFIs IAT and for a schematic of the RFIs IAT procedure). lationship). Two RFIs Thermometers were created: 1.) the RFIs The target categories of ”Client X” (the name of the client rep- Warm/Cold Intervention Thermometer, designed to measure resenting RFIs opportunities) and “Client Y” (the name of the explicit ratings of warmness or coolness toward RFIs; 2.) the client representing daily life opportunities), as well as the terms RFIs Approach/Avoid Thermometer designed to measure how “approach” and “avoid,” were displayed in the appropriate upper likely an individual is to use the therapeutic relationship (RFIs) corners of the screen throughout all of the tasks. Participants as a therapy technique. Positive scores on the thermometers in- were required to correct errors to continue with the task (the dicate positive feelings or preferences to approach RFIs. Nega- response latency was recorded throughout the error correction tive scores on these measures were representative of negative process). feelings or preferences to avoid RFIs. The structure and procedure of the RFIs IAT is similar to oth- PROCEDURE er seven block IATs (e.g., Teachman, Wilson, & Komarovskaya, 2006). The IAT is a response time task that requires participants Participants for the Mental Health Trainees sample (MHT) to categorize stimuli that belong to the category (i.e., Client X, were recruited via postings on student listservs of professional organizations. Directors of Clinical Training and Graduate Pro- :(cid:7)$(cid:23)(cid:5)(cid:7)(cid:20)(cid:4)(cid:4)(cid:13)(cid:21)(cid:9)(cid:25)(cid:5)(cid:9)(cid:10)(cid:7)(cid:14)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)!(cid:14)(cid:25)(cid:20)(cid:9)(cid:7)(cid:10)(cid:14)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)(cid:7);(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)!(cid:14)(cid:25)(cid:20)(cid:9)(cid:7)(cid:10)(cid:14)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)(cid:7)<(cid:7)!(cid:20)(cid:4)(cid:7)(cid:2)(cid:14)(cid:3)(cid:9)(cid:10)(cid:5)(cid:11))(cid:20)(cid:30)(cid:20)(cid:9)(cid:2)(cid:5)(cid:6)(cid:26)(cid:7) gram Coordinators from training programs and internships in $(cid:23)(cid:5)(cid:7)(cid:29)(cid:11)(cid:5)(cid:4)(cid:5)(cid:9)(cid:10)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)(cid:14)(cid:11)(cid:6)(cid:5)(cid:11)(cid:7)(cid:14)(cid:22)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)(cid:7);(cid:7)(cid:15)(cid:16)(cid:17)(cid:8)(cid:7)(cid:14)(cid:29)(cid:29)(cid:14)(cid:11)(cid:10)(cid:3)(cid:9)(cid:13)(cid:10)(cid:13)(cid:5)(cid:4)(cid:18)(cid:7)(cid:14)(cid:22)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)(cid:7)<(cid:7)(cid:15)(cid:6)(cid:20)(cid:13)(cid:30).(cid:7)(cid:30)(cid:13)(cid:22)(cid:5)(cid:7)(cid:14)(cid:29)(cid:29)(cid:14)(cid:11)(cid:10)(cid:3)(cid:9)(cid:13)(cid:10)(cid:13)(cid:5)(cid:4)(cid:18)(cid:7)!(cid:20)(cid:4)(cid:7)(cid:20)(cid:30)(cid:4)(cid:14)(cid:7) (cid:2)(cid:14)(cid:3)(cid:9)(cid:10)(cid:5)(cid:11))(cid:20)(cid:30)(cid:20)(cid:9)(cid:2)(cid:5)(cid:6)(cid:26) psychology, psychiatry, and social work and colleagues of the THERAPISTS’ ATTITUDES ABOUT AND PREFERENCES TO USE RELATIONSHIP FOCUSED INTERVENTIONS 141 researchers were also emailed to solicit participation of eligible endorsed knowing a friend or family member suffering from participants. FAP community members were recruited through depression (43.8%) or a substance use disorder (41.0%). the FAP listserv and through contacts with professional col- Demographics: FAP Community Members (n = 49). Due to concerns leagues. All individuals who participated in the study were eligi- about the possibility of identifying a FAP community member ble to enter a drawing to win one of four $50.00 gift certificates. based on their age, categorical response options for age were All study assessments and documents were located on a web- used (e.g., age 20 – 25). The most frequently occurring age site programmed using Web Inquisit (Inquisit 3.0.3.1.0). After group in the sample was 26 – 30 years old (32.7%) followed by reviewing the description of the study and the procedure for en- 50 years or older (22.4%). Approximately 65% of FAP members tering the drawing for the gift certificate, participants completed identified as female and 35% identified as male. Caucasian was the measures described above and other measures from a study the most frequently identified race/ethnicity by FAP partici- on stigmatizing attitudes about mental illness. The presentation pants (84.0%) with other race/ethnicities identified by less than order of the study measures and tasks were counterbalanced. 6% of the sample. FAP community members tended to be well- IAT Effect (the D Measure). The D measure is the preferred algorithm educated with 49.0% having a Doctorate’s degree, 42.9% with a to calculate the IAT effect, a measure of the relative strength of Master’s Degree, and 2.0% with a Medical Degree. Of the FAP associations of the concepts with attributes (Greenwald et al., participants who were currently in graduate school, the majority were in their 4th year of graduate school or beyond (34.7%). 2003). In this study a positive D score on the RFIs IAT indicated The theoretical orientation identified by a majority of the sample a greater preference to approach RFIs opportunities relative to was behavioral (57.1%) with cognitive-behavioral the second avoiding RFIs opportunities. most frequently endorsed theoretical orientation (20.4%). The DATA ANALYSIS mean caseload for FAP participants was 18.2 (SD = 30.6, range Hypothesis Testing. Hierarchical (sequential) regressions and Pear- 1 - 200). A substantial portion of participants reported having a son product-moment correlations were conducted to examine friend or family member suffering from depression (57.1%) or the hypotheses of the study. For all hierarchical regressions, substance use (34.7%). group membership (MHTs vs. FAP community members) was In regards to training in FAP, unfortunately 43.1% of the sam- entered first. The order of entry for the remaining predictor ple did not provide a response to this specific question. Of the variables was determined by theoretical considerations. The re- participants who responded 17.5% stated that they had received gression model that produced the best fit of the data is reported. training in FAP for less than 1 year, 14.0% stated that they had been practicing/learning FAP for 5 – 10 years, and 9.2% stated (cid:2) RESULTS that they had between 3-5 years of training. Less than 10% of the sample responded that they had received 2-3 years or had EXCLUSION OF SUBJECTS over 10 years of training. The sample varied widely in number of years practicing FAP with 38.6% stating they have been practic- A total of 164 MHTs and 56 FAP community members com- ing for over 3 years and 12.3% stating they have been practicing pleted the study. Based on recommendations from previous for less than 1 year. IAT researchers (Greenwald et al., 2003; Nosek et al., 2007), individuals with IAT data that contained an error rate of greater EXPLICIT ATTITUDES ABOUT AND PREFERENCES TO USE RFIS than 35%, those whose data included extremely long latencies On average, mental health care trainees endorsed very positive (greater than 3,000 ms), and those with 10% or more of their la- attitudes and beliefs about RFIs. The mean score on the TRM tencies faster than 300 ms were omitted from the study. Twenty- for the mental health care trainee sample was 28.55 (SD = 9.95) seven participants were excluded (20 were MHTs, 7 were FAP with a range of 2.00 to 42.00. Overall, FAP community members community members) due to incomplete data (defined as 20% endorsed extremely positive attitudes and beliefs about RFIs. or more of data missing across study measures), or because their The mean score on the TRM for the FAP community member data were duplicated and recorded multiple times, or because sample was 37.28 (SD = 5.32) and mean scores ranged from IAT performance did not meet the criteria outlined above. 21.00 to 42.00. DEMOGRAPHICS RFIs Thermometers. On average, FAP community members had higher scores on RFIs Warm Cold thermometer (M = 2.84, SD Demographics: National Sample of Mental Health Care Trainees (MHTs) (n = 144). The mean age in the MHT sample was 29.6 years (SD = = 0.37) than MHTs (M = 1.67, SD = 1.16). Similar to the means on the RFIs Warm Cold Thermometer, the mean of the FAP 6.0, range 19 - 57). Approximately 80% (81.3%) of the sample sample on the RFIs Approach Avoid Thermometer (M = 2.52, identified as female and 18.7% as male. The sample was pre- SD = 0.51) was higher than the mean of the MHT sample (M = dominately Caucasian (87.5%) with other races and ethnicities 1.61, SD = 0.99). identified by less than 5% of the sample. Most (52.8%) reported a highest level of education as a Master’s Degree, with 45.1% IDENTIFICATION OF POTENTIAL PREDICTOR VARIABLES reporting a Bachelor’s Degree, and 2.1% reporting a Doctorate No demographic variables (e.g., race, gender) had a significant Degree. Over half of the participants in this sample identified impact on the study measures (all p’s > .05). Variables related their theoretical orientation as Cognitive-Behavioral followed to participants’ training, theoretical orientation, caseload, and by eclectic/integrative. The average caseload of the participants current treatment of a client with depression or substance use was 12 (SD = 18.7, range 1 - 200. Approximately half of MHTs disorder had significant effects on study measures, although the 142 TERRY & KOHLENBERG Table 1. Correlations Between Variables Relating to Explicit Attitudes about Relationship Focused Interventions (n=193). Measure 1 2 3 4 5 6 :(cid:26)(cid:7)Therapeutic Relationship Measure – Q(cid:26)X&&ZZ Q(cid:26)XX’ZZ (cid:26)[\>ZZ (cid:26)&>]ZZ Q(cid:26):[X >(cid:26)(cid:7)2(cid:11)(cid:14)(cid:3)(cid:29)(cid:7)(cid:25)(cid:5)(cid:25))(cid:5)(cid:11)(cid:4)(cid:23)(cid:13)(cid:29)(cid:7)(cid:15)6^$(cid:7)(cid:12)(cid:4)(cid:26)(cid:7)(cid:17)"#(cid:18) – (cid:26):J[ Q(cid:26)\\\ZZ Q(cid:26)XJ&ZZ (cid:26)’’] X(cid:26)(cid:7)$(cid:23)(cid:5)(cid:14)(cid:11)(cid:5)(cid:10)(cid:13)(cid:2)(cid:20)(cid:30)(cid:7)(cid:14)(cid:11)(cid:13)(cid:5)(cid:9)(cid:10)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)(cid:15)+7$(cid:7)(cid:12)(cid:4)(cid:26)(cid:7)0(cid:10)(cid:23)(cid:5)(cid:11)(cid:18) – Q(cid:26):>] Q(cid:26):&J (cid:26)’’> \(cid:26)(cid:7)_(cid:20)(cid:11)(cid:25)(cid:7)+(cid:14)(cid:30)(cid:6)(cid:7)$(cid:23)(cid:5)(cid:11)(cid:25)(cid:14)(cid:25)(cid:5)(cid:10)(cid:5)(cid:11) – (cid:26)&:’ZZ Q(cid:26):&& *(cid:26)(cid:7)Approach –Avoid Thermometer – Q(cid:26):\> [(cid:26)(cid:7)(cid:16)(cid:17)(cid:8)(cid:4)(cid:7)(cid:8)"$(cid:7)3(cid:7)‘(cid:2)(cid:14)(cid:11)(cid:5) – n’s for many of these demographic questions were not sufficient included group membership, theoretical orientation, and the to conduct the appropriate inferential statistical tests (i.e., n’s explicit RFIs thermometer measures was the best predictor of < 30; the exception was the theoretical orientation variable in explicit attitudes about RFIs, F(4, 70) = 26.62, p < 0.001, R2 = which there was sufficient n to conduct the analyses). 0.60. These results suggest that explicit attitudes about RFIs in- Mental Health Trainees. Results with MHTs were contrary to our terventions are likely to be influenced by group membership, an individual’s theoretical orientation, and an individuals’ reported expectation. The mean score on the TRM (the explicit measure of attitudes about RFIs) for MHTs was M = 28.58, (SD = 9.75) level of warmth towards RFIs (Warm Cold RFIs Thermometer) and their explicit preference to use RFIs (Approach Avoid RFIs with a range of 2.00 to 42.00 indicating positive attitudes about Thermometer). RFIs. The mean D score on the RFIs IAT (the implicit measure of preferences to use RFIs) for MHTs was also positive, M = 0.10 The difference between FAP (D = 0.16, SD = 0.46) and MHT (SD = 0.38), indicating a preference to approach RFIs oppor- (D = 0.11, SD = 0.39) groups on the implicit RFIs preference measure approached significance, t(102) = -1.79, p = .08. A hi- tunities relative to avoid RFIs opportunities. The relationship erarchical regression was conducted to examine if group mem- between implicit and explicit attitudes about RFIs interventions in mental health care trainees was positive, but not significant, r bership (MHT vs. FAP) and other study variables (selected for = .18, p = .08. To facilitate comparison between the implicit and theoretical reasons or based on the empirical literature on RFIs) explicit measure, Cohen’s d effect sizes were calculated using the significantly predicted RFIs IAT D scores (implicit RFIs preference). The potential predictors selected and the order they were difference between the mean on each measure and the score in- entered into the model were: theoretical orientation, the explicit dicating “no preference” on each measure (a score of 0 on each measure). The effect size of the RFIs IAT was 0.28, a small effect RFIs thermometer measures (entered simultaneously), and explicit attitudes about RFIs (TRM). The regression model pre- (Cohen, 1988). The effect size of the explicit preference to use dicted approximately 4% of the variance in RFIs IAT D scores RFIs was 1.62, a large effect (Cohen). and was not significant (p = .53). Between group comparisons. Average scores on the TRM were sig- Effect of patient diagnosis. An ANCOVA was conducted to examine nificantly higher for FAP participants (M=37.43, SD = 5.42) the influence of client description (cocaine vs. other diagnoses) compared to MHTs (M = 28.58, SD = 9.75), t(155) = 5.69, p < on RFIs IAT D scores while controlling for the effect of group .001, d = 1.12. In addition to group membership, the influence membership (MHT vs. FAP). The covariate, group membership, of other potential predictor variables (identified by theory and did not significantly affect RFIs IAT D scores, F(1, 104) = 0.16, review of the empirical literature on RFIs) on TRM scores was p = .686. Because group membership did not influence RFI IAT examined by conducting a hierarchical regression. After enter- D scores, the groups were combined and an ANOVA was con- ing the group membership, potential predictor variables were ducted to examine the influence of client description on RFIs entered in the following order: theoretical orientation2, RFIs IAT D scores. The ANOVA was not significant, F(2, 104) = 1.78, thermometer measures, and RFIs IAT D scores (see Table 1). p = .173. A hierarchical regression was done to examine if other Group membership was a significant predictor of explicit atti- study variables (selected for theoretical reasons) predicted im- tudes about RFIs, F(1, 73) = 12.07, p = .001, R2 = .14. The second plicit preference to use RFIs. With the exception of the correla- step of the model (entry of the theoretical orientation variable tion between the explicit attitudes about RFIs (TRM) and RFIs into the regression model) resulted in a significant change in R2, IAT, correlations between the predictor variables and RFIs IAT F(2, 72) = 9.58, p = .02. Entry of the explicit RFIs thermometer D scores were not significant (p > .05). The regression models measures (the third step of the regression model) resulted in a predicted less than 3% of the variance in RFIs IAT D scores and significant change in R2, F(4, 70) = 26.62, p < .001. The final step were not significant (p = .20). Based on these results, a client’s of the model (entry of the RFIs IAT D scores) did not result in diagnosis or a practitioner’s theoretical orientation does not ap- a significant change in R2, F(5, 69) = 21.19, p = 0.53. Based on pear to influence a therapist’s implicit preferences toward RFIs. the results of the hierarchical regression, the third model that (cid:2) DISCUSSION 2 We selected theoretical orientation as a potential predictor variable because we believed that there may be differential emphasis on the use of the RFI dependent on an individual’s theoretical The study was a preliminary attempt to examine attitudes about (cid:14)(cid:11)(cid:13)(cid:5)(cid:9)(cid:10)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:26)(cid:7)"(cid:6)(cid:6)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:20)(cid:30)(cid:30).(cid:19)(cid:7)(cid:29)(cid:3))(cid:30)(cid:13)(cid:4)(cid:23)(cid:5)(cid:6)(cid:7)(cid:11)(cid:5)(cid:4)(cid:5)(cid:20)(cid:11)(cid:2)(cid:23)(cid:7)(cid:23)(cid:20)(cid:4)(cid:7)(cid:11)(cid:5)(cid:12)(cid:5)(cid:20)(cid:30)(cid:5)(cid:6)(cid:7)(cid:10)(cid:23)(cid:20)(cid:10)(cid:7)(cid:29)(cid:11)(cid:20)(cid:2)(cid:10)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:5)(cid:11)(cid:4)(cid:7)(cid:10)(cid:11)(cid:20)(cid:13)(cid:9)(cid:5)(cid:6)(cid:7)(cid:13)(cid:9)(cid:7)+(cid:14)(cid:21)(cid:9)(cid:13)(cid:10)(cid:13)(cid:12)(cid:5)(cid:7) and preferences to use an important technique in FAP, the Re- $(cid:23)(cid:5)(cid:11)(cid:20)(cid:29).(cid:7)(cid:22)(cid:14)(cid:11)(cid:7)3(cid:5)(cid:29)(cid:11)(cid:5)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:7)(cid:14)(cid:11)(cid:7)7(cid:5)(cid:23)(cid:20)(cid:12)(cid:13)(cid:14)(cid:11)(cid:20)(cid:30)(cid:7)"(cid:2)(cid:10)(cid:13)(cid:12)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)(cid:6)(cid:14)(cid:7)(cid:9)(cid:14)(cid:10)(cid:7)(cid:10)(cid:5)(cid:9)(cid:6)(cid:7)(cid:10)(cid:14)(cid:7)(cid:3)(cid:4)(cid:5)(cid:7)(cid:16)(cid:17)(cid:8)(cid:4)(cid:7)(cid:15)7(cid:14)(cid:30)(cid:30)(cid:13)(cid:9)(cid:21)(cid:7)(cid:5)(cid:10)(cid:7)(cid:20)(cid:30)(cid:26)(cid:19)(cid:7)>’’>?(cid:7) @(cid:14)(cid:23)(cid:30)(cid:5)(cid:9))(cid:5)(cid:11)(cid:21)(cid:7)(cid:5)(cid:10)(cid:7)(cid:20)(cid:30)(cid:26)(cid:19)(cid:7)>’’>?(cid:7)@(cid:20)(cid:9)(cid:10)(cid:5)(cid:11)(cid:7)(cid:5)(cid:10)(cid:7)(cid:20)(cid:30)(cid:26)(cid:19)(cid:7)>’’J(cid:18)(cid:26) lationship Focused Intervention (RFIs). Additionally, we sought THERAPISTS’ ATTITUDES ABOUT AND PREFERENCES TO USE RELATIONSHIP FOCUSED INTERVENTIONS 143 to examine how therapist and client factors might influence of the small n of practitioners assigned to each of the conditions explicit and implicit attitudes and preferences to use RFIs. No (Cocaine Condition n = 29; Major Depression n = 37; No Diag- published measures on RFIs attitudes or preferences could be nosis n = 38). 3Because of the small n’s in each condition there located therefore one of the critical tasks of the study was to may been insufficient power to detect small, but potentially im- create reliable and viable measures of therapists’ attitudes about portant differences between the groups. Future research should and preferences to use RFIs. The measures created for the study, further examine if client diagnosis or other client characteristics including the implicit measure (the RFIs IAT) appear to be re- impact preferences toward and actual use of RFIs. liable and viable, although further research on their reliability The discrepancy between self-reported preferences and im- and validity are needed. plicit preferences to use RFIs is consistent with other studies of We believed that MHTs would display an implicit preference constructs that are subject to self-presentation biases or that to avoid RFIs; however, both MHTs and FAP community mem- may be difficult to introspect about (Greenwald, Poehlman, bers displayed implicit preferences to approach RFIs. Discrep- Uhlmann, & Banaji, 2009; Nosek et al., 2007). It is important ancies between explicit and implicit preferences to approach to note that the discrepancy between explicit attitudes about/ RFIs were discovered, suggesting that implicit preferences may preferences for RFIs and implicit preferences to use RFIs was be less subject to self-presentation biases or an individual’s not just found in therapists without specialized training in RFIs. awareness of his/her preferences. Specialized training in RFIs Results from this study suggest that therapists with specialized influenced individuals’ explicit and implicit preferences to use training in RFIs also display these discrepancies. One interpre- RFIs, as well as their attitudes about RFIs. Individuals with spe- tation of these findings is that social desirability influences ex- cialized training in RFIs (i.e., FAP community members) had plicit attitudes/preferences for RFIs (i.e., practitioners report in- higher scores (indicating greater likelihood to use RFIs or more creased positive feelings about and likelihood to use RFIs), but positive attitudes about RFIs) on implicit and explicit measures is less likely to influence implicit preferences for RFIs. Another about RFIs. For practitioners interested in using RFIs and for interpretation is that practitioners may have more difficulty ac- practitioners interested in training other mental health pro- cessing and reflecting upon their preferences to use RFIs. Be- fessionals to use RFIs, results from this research indicate that cause research on the IAT has shown that implicit and explicit training may influence practitioners’ attitudes and preferences measures of the same attitude differentially impact behavioral to use RFIs. Future studies should examine how the amount of outcomes, future studies should examine which therapeutic training and types of trainings in RFIs affect explicit and im- outcomes are best predicted by explicit measures of RFIs and plicit preferences and attitudes about RFIs. Additionally, within which outcomes are best predicted by implicit measures of RFIs. subject studies of how these preferences and attitudes change LIMITATIONS AND FUTURE DIRECTIONS across time with training would be helpful in describing and An important limitation of the research was the small sample understanding how training affects RFIs preferences and atti- size of FAP practitioners and the MHTs assigned to the Cocaine tudes, and subsequently may lead to improvements in training Diagnosis condition of the RFIs IAT task. Future studies should practitioners to use RFIs. attempt to replicate the findings of the current study by using In addition to specialized training in RFIs, theoretical orien- a larger sample of practitioners. Some potential predictor vari- tation appeared to affect preference for RFIs. Practitioners iden- ables (e.g., training in FAP, identification of a psychodynamic tifying with a CBT orientation had significantly lower scores on theoretical orientation) were not entered into the regression the explicit measure of attitudes about RFIs than MHTs who models because of insufficient sample size to warrant their in- endorsed a non-CBT orientation. This finding is consistent with clusion in the models. It is also relevant to note that this study results in published empirical studies about the low occurrence examined preferences to use RFIs rather than actual reported of RFIs in therapists trained in Cognitive Therapy and Behav- use of RFIs. It awaits further research to determine the extent to ioral Activation for Depression (Bolling et al., 2000; Kohlenberg which preferences predict actual use of RFIs. et al., 2002; Kanter et al., 2009).The reason for this difference in preferences is uncertain. While training in CBT does not pro- (cid:2) CONCLUSION hibit the use of RFIs, it may be that the lack of specialized training in RFIs prevents the development of positive attitudes and The study was an attempt to create reliable and viable measures preferences to use of RFIs. of practitioners’ attitudes about and preferences to use an important FAP technique, Relationship Focused Interventions RELATIONSHIP OF CLIENT DIAGNOSIS AND PREFERENCES TO USE (RFIs). Additionally, we attempted to examine the influence RFIS of therapist and client variables on practitioners’ attitudes and To our surprise, a client’s diagnosis of Cocaine Dependence preferences to use RFIs. Results from the study indicate that we did not influence practitioners’ implicit or explicit preferences were successful in creating reliable and usable measures. Fur- to use RFIs. We believed that practitioners’ beliefs or attitudes thermore, results suggest the importance of assessing both im- about substance use would have influenced practitioners to plicit and explicit attitudes and preferences. Finally, we showed avoid using therapeutic interventions that require interpersonal that therapist training in RFIs may influence attitudes and pref- closeness on the part of the therapist. However, the results from erences for RFIs. We hope that researchers interested in RFIs the study suggest that a client diagnosis of a substance use dis- X(cid:7)_(cid:5)(cid:7)(cid:2)(cid:14)(cid:9)(cid:6)(cid:3)(cid:2)(cid:10)(cid:5)(cid:6)(cid:7)(cid:4)(cid:5)(cid:12)(cid:5)(cid:11)(cid:20)(cid:30)(cid:7)(cid:20)(cid:9)(cid:20)(cid:30).(cid:4)(cid:5)(cid:4)(cid:7)(cid:10)(cid:14)(cid:7)(cid:6)(cid:5)(cid:10)(cid:5)(cid:11)(cid:25)(cid:13)(cid:9)(cid:5)(cid:7)(cid:13)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:11)(cid:5)(cid:7)!(cid:5)(cid:11)(cid:5)(cid:7)(cid:20)(cid:9).(cid:7)(cid:4)(cid:13)(cid:21)(cid:9)(cid:13)8(cid:2)(cid:20)(cid:9)(cid:10)(cid:7)(cid:6)(cid:13)(cid:22)(cid:22)(cid:5)(cid:11)(cid:5)(cid:9)(cid:2)(cid:5)(cid:4)(cid:7)(cid:20)(cid:25)(cid:14)(cid:9)(cid:21)(cid:7) order does not significantly impact practitioners’ preferences to (cid:10)(cid:23)(cid:5)(cid:7)(cid:29)(cid:20)(cid:11)(cid:10)(cid:13)(cid:2)(cid:13)(cid:29)(cid:20)(cid:9)(cid:10)(cid:4)(cid:7)(cid:13)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:2)(cid:14)(cid:9)(cid:6)(cid:13)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:9)(cid:14)(cid:7)(cid:4)(cid:13)(cid:21)(cid:9)(cid:13)8(cid:2)(cid:20)(cid:9)(cid:10)(cid:7)(cid:6)(cid:13)(cid:22)(cid:22)(cid:5)(cid:11)(cid:5)(cid:9)(cid:2)(cid:5)(cid:4)(cid:7)(cid:14)(cid:9)(cid:7)(cid:20)(cid:9).(cid:7)(cid:14)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:4)(cid:10)(cid:3)(cid:6).(cid:7)(cid:25)(cid:5)(cid:20)(cid:4)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7) use RFIs. The results should be interpreted with caution because !(cid:5)(cid:11)(cid:5)(cid:7)(cid:6)(cid:13)(cid:4)(cid:2)(cid:14)(cid:12)(cid:5)(cid:11)(cid:5)(cid:6)(cid:26) 144 TERRY & KOHLENBERG will continue to investigate the use of RFIs and the factors that @(cid:13)(cid:25)(cid:19)(cid:7)3(cid:26)(cid:7)(cid:15)>’’X(cid:18)(cid:26)(cid:7)j(cid:14)(cid:30)(cid:3)(cid:9)(cid:10)(cid:20)(cid:11).(cid:7)(cid:2)(cid:14)(cid:9)(cid:10)(cid:11)(cid:14)(cid:30)(cid:30)(cid:20))(cid:13)(cid:30)(cid:13)(cid:10).(cid:7)(cid:14)(cid:22)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:8)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)"(cid:4)(cid:4)(cid:14)(cid:2)(cid:13)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)$(cid:5)(cid:4)(cid:10)(cid:7)(cid:15)(cid:8)"$(cid:18)(cid:26)(cid:7)Social influence therapists’ use of RFIs. Psychology Quarterly, 66(cid:15):(cid:18)(cid:19)(cid:7)]X(cid:7)k(cid:7)J[(cid:26) @(cid:14)(cid:23)(cid:30)(cid:5)(cid:9))(cid:5)(cid:11)(cid:21)(cid:19)(cid:7)(cid:16)(cid:26)(cid:7)4(cid:26)(cid:19)(cid:7)@(cid:20)(cid:9)(cid:10)(cid:5)(cid:11)(cid:19)(cid:7)4(cid:26)(cid:7)_(cid:26)(cid:19)(cid:7)7(cid:14)(cid:30)(cid:30)(cid:13)(cid:9)(cid:21)(cid:19)(cid:7)6(cid:26)(cid:7)<(cid:26)(cid:19)(cid:7)#(cid:20)(cid:11)1(cid:5)(cid:11)(cid:19)(cid:7)+(cid:26)(cid:7)(cid:16)(cid:26)(cid:19)(cid:7)q(cid:7)$(cid:4)(cid:20)(cid:13)(cid:19)(cid:7)6(cid:26)(cid:7)(cid:15)>’’>(cid:18)(cid:26)(cid:7)(cid:27)(cid:9)- (cid:2) REFERENCES hancing cognitive therapy for depression with Functional Analytic Psychotherapy: $(cid:11)(cid:5)(cid:20)(cid:10)(cid:25)(cid:5)(cid:9)(cid:10)(cid:7)(cid:21)(cid:3)(cid:13)(cid:6)(cid:5)(cid:30)(cid:13)(cid:9)(cid:5)(cid:4)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:5)(cid:25)(cid:29)(cid:13)(cid:11)(cid:13)(cid:2)(cid:20)(cid:30)(cid:7)8(cid:9)(cid:6)(cid:13)(cid:9)(cid:21)(cid:4)(cid:26)(cid:7)Cognitive and Behavioral Practice, "(cid:9)(cid:21)(cid:5)(cid:11)(cid:25)(cid:5).(cid:5)(cid:11)(cid:7)6(cid:26)(cid:7)+(cid:26)(cid:19)(cid:7)q(cid:7)3(cid:13)(cid:5)(cid:10)(cid:11)(cid:13)(cid:2)(cid:23)(cid:19)(cid:7)‘(cid:26)(cid:7)(cid:15)>’’[(cid:18)(cid:26)(cid:7)#(cid:3))(cid:30)(cid:13)(cid:2)(cid:7))(cid:5)(cid:30)(cid:13)(cid:5)(cid:22)(cid:4)(cid:7)(cid:20))(cid:14)(cid:3)(cid:10)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:20)(cid:10)(cid:10)(cid:13)(cid:10)(cid:3)(cid:6)(cid:5)(cid:4)(cid:7)(cid:10)(cid:14)!(cid:20)(cid:11)(cid:6)(cid:4)(cid:7) 9(cid:15)X(cid:18)(cid:19)(cid:7)>:X(cid:7)k(cid:7)>>J(cid:26) 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66(cid:15)\(cid:18)(cid:19)(cid:7)[X\(cid:7)k(cid:7)[\’(cid:26) chology, 66(cid:15)*(cid:18)(cid:19)(cid:7)]’X(cid:7)k(cid:7)]:’(cid:26) (cid:2) AUTHOR CONTACT INFORMATION 2(cid:11)(cid:5)(cid:5)(cid:9)!(cid:20)(cid:30)(cid:6)(cid:19)(cid:7)"(cid:26)(cid:7)2(cid:26)(cid:19)(cid:7)6(cid:2)2(cid:23)(cid:5)(cid:5)(cid:19)(cid:7)3(cid:26)(cid:7)(cid:27)(cid:26)(cid:19)(cid:7)q(cid:7)‘(cid:2)(cid:23)!(cid:20)(cid:11)(cid:10)~(cid:19)(cid:7)4(cid:26)(cid:7)5(cid:26)(cid:7)@(cid:26)(cid:7)(cid:15):JJ](cid:18)(cid:26)(cid:7)6(cid:5)(cid:20)(cid:4)(cid:3)(cid:11)(cid:13)(cid:9)(cid:21)(cid:7)(cid:13)(cid:9)(cid:6)(cid:13)(cid:12)(cid:13)(cid:6)(cid:3)(cid:20)(cid:30)(cid:7) 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TERRY, PH.D. 2(cid:11)(cid:5)(cid:5)(cid:9)!(cid:20)(cid:30)(cid:6)(cid:19)(cid:7)"(cid:26)(cid:7)2(cid:26)(cid:19)(cid:7)z(cid:14)(cid:4)(cid:5)1(cid:19)(cid:7)7(cid:26)(cid:7)"(cid:26)(cid:19)(cid:7)q(cid:7)7(cid:20)(cid:9)(cid:20)|(cid:13)(cid:19)(cid:7)6(cid:26)(cid:7)(cid:16)(cid:26)(cid:7)(cid:15)>’’X(cid:18)(cid:26)(cid:7)}(cid:9)(cid:6)(cid:5)(cid:11)(cid:4)(cid:10)(cid:20)(cid:9)(cid:6)(cid:13)(cid:9)(cid:21)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:3)(cid:4)(cid:13)(cid:9)(cid:21)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7) #(cid:14)(cid:11)(cid:10)(cid:30)(cid:20)(cid:9)(cid:6)(cid:7)#(cid:4).(cid:2)(cid:23)(cid:14)(cid:10)(cid:23)(cid:5)(cid:11)(cid:20)(cid:29).(cid:7)+(cid:30)(cid:13)(cid:9)(cid:13)(cid:2)(cid:19)(cid:7)(cid:16)(cid:5)(cid:4)(cid:5)(cid:20)(cid:11)(cid:2)(cid:23)(cid:19)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)$(cid:11)(cid:20)(cid:13)(cid:9)(cid:13)(cid:9)(cid:21) (cid:8)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)"(cid:4)(cid:4)(cid:14)(cid:2)(cid:13)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)$(cid:5)(cid:4)(cid:10){(cid:7)(cid:8)(cid:26)(cid:7)"(cid:9)(cid:7)(cid:13)(cid:25)(cid:29)(cid:11)(cid:14)(cid:12)(cid:5)(cid:6)(cid:7)(cid:4)(cid:2)(cid:14)(cid:11)(cid:13)(cid:9)(cid:21)(cid:7)(cid:20)(cid:30)(cid:21)(cid:14)(cid:11)(cid:13)(cid:10)(cid:23)(cid:25)(cid:26)(cid:7)Journal of Personality :]X’(cid:7)z(cid:27)(cid:7)2(cid:11)(cid:20)(cid:9)(cid:6)(cid:7)"(cid:12)(cid:5)(cid:26) and Social Psychology, 85(cid:15)>(cid:18)(cid:19)(cid:7):J&(cid:7)k(cid:7)>:[(cid:26) #(cid:14)(cid:11)(cid:10)(cid:30)(cid:20)(cid:9)(cid:6)(cid:19)(cid:7)0(cid:16)(cid:26)(cid:7)J&>:> 2(cid:11)(cid:5)(cid:5)(cid:9)!(cid:20)(cid:30)(cid:6)(cid:19)(cid:7)"(cid:26)(cid:7)2(cid:26)(cid:19)(cid:7)#(cid:14)(cid:5)(cid:23)(cid:30)(cid:25)(cid:20)(cid:9)(cid:19)(cid:7)$(cid:26)(cid:7)"(cid:26)(cid:19)(cid:7)}(cid:23)(cid:30)(cid:25)(cid:20)(cid:9)(cid:9)(cid:19)(cid:7)(cid:27)(cid:26)(cid:7)5(cid:26)(cid:19)(cid:7)q(cid:7)7(cid:20)(cid:9)(cid:20)|(cid:13)(cid:19)(cid:7)6(cid:26)(cid:7)(cid:16)(cid:26)(cid:7)(cid:15)>’’J(cid:18)(cid:26)(cid:7)}(cid:9)- (cid:27)(cid:25)(cid:20)(cid:13)(cid:30){(cid:7)(cid:2)(cid:23)(cid:11)(cid:13)(cid:4)(cid:10)(cid:5)(cid:13)(cid:9)(cid:5)(cid:10)(cid:5)(cid:11)(cid:11).(cid:128)(cid:21)(cid:25)(cid:20)(cid:13)(cid:30)(cid:26)(cid:2)(cid:14)(cid:25) (cid:6)(cid:5)(cid:11)(cid:4)(cid:10)(cid:20)(cid:9)(cid:6)(cid:13)(cid:9)(cid:21)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:3)(cid:4)(cid:13)(cid:9)(cid:21)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:8)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)"(cid:4)(cid:4)(cid:14)(cid:2)(cid:13)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)$(cid:5)(cid:4)(cid:10){(cid:7)(cid:8)(cid:8)(cid:8)(cid:26)(cid:7)6(cid:5)(cid:10)(cid:20)Q(cid:20)(cid:9)(cid:20)(cid:30).(cid:4)(cid:13)(cid:4)(cid:7)(cid:14)(cid:22)(cid:7)(cid:29)(cid:11)(cid:5)(cid:6)(cid:13)(cid:2)(cid:10)(cid:13)(cid:12)(cid:5)(cid:7) (cid:12)(cid:20)(cid:30)(cid:13)(cid:6)(cid:13)(cid:10).(cid:26)(cid:7)Journal of Personality and Social Psychology, 97(cid:15):(cid:18)(cid:19)(cid:7):&(cid:7)k(cid:7)\:(cid:26) ROBERT J. KOHLENBERG, PH.D. (cid:8)(cid:9)(cid:129)(cid:3)(cid:13)(cid:4)(cid:13)(cid:10)(cid:7)X(cid:26)’(cid:26)X(cid:26):(cid:7)(cid:130)+(cid:14)(cid:25)(cid:29)(cid:3)(cid:10)(cid:5)(cid:11)(cid:7)(cid:4)(cid:14)(cid:22)(cid:10)!(cid:20)(cid:11)(cid:5)(cid:131)(cid:26)(cid:132)(cid:15)>’’](cid:18)(cid:26)(cid:132)‘(cid:5)(cid:20)(cid:10)(cid:10)(cid:30)(cid:5)(cid:19)(cid:7)_"{(cid:7)6(cid:13)(cid:30)(cid:30)(cid:13)(cid:4)(cid:5)(cid:2)(cid:14)(cid:9)(cid:6)(cid:7)‘(cid:14)(cid:22)(cid:10)!(cid:20)(cid:11)(cid:5)(cid:7)55+(cid:26) }(cid:9)(cid:13)(cid:12)(cid:5)(cid:11)(cid:4)(cid:13)(cid:10).(cid:7)(cid:14)(cid:22)(cid:7)_(cid:20)(cid:4)(cid:23)(cid:13)(cid:9)(cid:21)(cid:10)(cid:14)(cid:9)(cid:19)(cid:7)3(cid:5)(cid:29)(cid:20)(cid:11)(cid:10)(cid:25)(cid:5)(cid:9)(cid:10)(cid:7)(cid:14)(cid:22)(cid:7)#(cid:4).(cid:2)(cid:23)(cid:14)(cid:30)(cid:14)(cid:21). @(cid:20)(cid:9)(cid:10)(cid:5)(cid:11)(cid:19)(cid:7)4(cid:26)(cid:7)_(cid:26)(cid:19)(cid:7)5(cid:20)(cid:9)(cid:6)(cid:5)(cid:4)(cid:19)(cid:7)‘(cid:26)(cid:7)4(cid:26)(cid:19)(cid:7)^(cid:14)(cid:30)(cid:25)(cid:20)(cid:9)(cid:19)(cid:7)2(cid:26)(cid:7)(cid:8)(cid:26)(cid:19)(cid:7)(cid:16)(cid:3)(cid:4)(cid:2)(cid:23)(cid:19)(cid:7)5(cid:26)(cid:7)+(cid:26)(cid:19)(cid:7)_(cid:23)(cid:13)(cid:10)(cid:5)(cid:4)(cid:13)(cid:6)(cid:5)(cid:19)(cid:7)}(cid:26)(cid:19)(cid:7)q(cid:7)‘(cid:5)(cid:6)(cid:13)(cid:12).(cid:19)(cid:7)‘(cid:26)(cid:7)@(cid:26)(cid:7) 7(cid:14)(cid:28)(cid:7)X*:*>* (cid:15)>’’J(cid:18)(cid:26)(cid:7)$(cid:23)(cid:5)(cid:7)(cid:3)(cid:4)(cid:5)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:9)(cid:20)(cid:10)(cid:3)(cid:11)(cid:5)(cid:7)(cid:14)(cid:22)(cid:7)(cid:29)(cid:11)(cid:5)(cid:4)(cid:5)(cid:9)(cid:10)Q(cid:22)(cid:14)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:13)(cid:9)(cid:10)(cid:5)(cid:11)(cid:12)(cid:5)(cid:9)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:13)(cid:9)(cid:7)(cid:2)(cid:14)(cid:21)(cid:9)(cid:13)(cid:10)(cid:13)(cid:12)(cid:5)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7))(cid:5)- ‘(cid:5)(cid:20)(cid:10)(cid:10)(cid:30)(cid:5)(cid:19)(cid:7)_"(cid:26)(cid:7)J]:J* (cid:23)(cid:20)(cid:12)(cid:13)(cid:14)(cid:11)(cid:20)(cid:30)(cid:7)(cid:10)(cid:23)(cid:5)(cid:11)(cid:20)(cid:29)(cid:13)(cid:5)(cid:4)(cid:7)(cid:22)(cid:14)(cid:11)(cid:7)(cid:6)(cid:5)(cid:29)(cid:11)(cid:5)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:26)(cid:7)Psychotherapy Theory, Research, Practice, and Training, 46(cid:15)>(cid:18)(cid:19)(cid:7)>>’(cid:7)k(cid:7)>X>(cid:26) (cid:27)(cid:25)(cid:20)(cid:13)(cid:30){(cid:7)(cid:22)(cid:20)(cid:29)(cid:128)(cid:3)(cid:26)!(cid:20)(cid:4)(cid:23)(cid:13)(cid:9)(cid:21)(cid:10)(cid:14)(cid:9)(cid:26)(cid:5)(cid:6)(cid:3) THERAPISTS’ ATTITUDES ABOUT AND PREFERENCES TO USE RELATIONSHIP FOCUSED INTERVENTIONS 145 (cid:2) APPENDIX Note: #(cid:13)(cid:2)(cid:10)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)(cid:10)(cid:20)1(cid:5)(cid:9)(cid:7)(cid:22)(cid:11)(cid:14)(cid:25)(cid:7)(cid:27)1(cid:25)(cid:20)(cid:9)(cid:31)(cid:4)(cid:7)4(cid:20)(cid:29)(cid:20)(cid:9)(cid:5)(cid:4)(cid:5)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)+(cid:20)(cid:3)(cid:2)(cid:20)(cid:4)(cid:13)(cid:20)(cid:9)(cid:7)(cid:17)(cid:20)(cid:2)(cid:13)(cid:20)(cid:30)(cid:7)(cid:27)(cid:28)(cid:29)(cid:11)(cid:5)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:7)(cid:14)(cid:22)(cid:7)(cid:27)(cid:25)(cid:14)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:15)4"+(cid:17)(cid:27)(cid:27)?(cid:7)6(cid:20)(cid:10)(cid:4)(cid:3)(cid:25)(cid:14)(cid:10)(cid:14)(cid:7)q(cid:7)(cid:27)1(cid:25)(cid:20)(cid:9)(cid:19)(cid:7):J]](cid:18)(cid:26)(cid:7)#(cid:13)(cid:2)(cid:10)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)(cid:29)(cid:3))(cid:30)(cid:13)(cid:4)(cid:23)(cid:5)(cid:6)(cid:7)!(cid:13)(cid:10)(cid:23)(cid:7)(cid:29)(cid:5)(cid:11)(cid:25)(cid:13)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:26) Figure 1. (cid:27)(cid:28)(cid:20)(cid:25)(cid:29)(cid:30)(cid:5)(cid:7)(cid:14)(cid:22)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)Q$(cid:23)(cid:5)(cid:11)(cid:20)(cid:29)(cid:13)(cid:4)(cid:10)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)+(cid:30)(cid:13)(cid:5)(cid:9)(cid:10)Q(cid:8)(cid:25)(cid:29)(cid:14)(cid:11)(cid:10)(cid:20)(cid:9)(cid:10)(cid:7)0(cid:10)(cid:23)(cid:5)(cid:11)(cid:7)‘(cid:10)(cid:14)(cid:11).)(cid:14)(cid:20)(cid:11)(cid:6)(cid:4)(cid:26) 146 TERRY & KOHLENBERG CONCEPT CONTRASTS FOR IVI IAT Note: #(cid:13)(cid:2)(cid:10)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)!(cid:5)(cid:11)(cid:5)(cid:7)(cid:10)(cid:20)1(cid:5)(cid:9)(cid:7)(cid:22)(cid:11)(cid:14)(cid:25)(cid:7)(cid:27)1(cid:25)(cid:20)(cid:9)(cid:31)(cid:4)(cid:7)4(cid:20)(cid:29)(cid:20)(cid:9)(cid:5)(cid:4)(cid:5)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)+(cid:20)(cid:3)(cid:2)(cid:20)(cid:4)(cid:13)(cid:20)(cid:9)(cid:7)(cid:17)(cid:20)(cid:2)(cid:13)(cid:20)(cid:30)(cid:7)(cid:27)(cid:28)(cid:29)(cid:11)(cid:5)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:7)(cid:14)(cid:22)(cid:7)(cid:27)(cid:25)(cid:14)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:15)4"+(cid:17)(cid:27)(cid:27)?(cid:7)6(cid:20)(cid:10)(cid:4)(cid:3)(cid:25)(cid:14)(cid:10)(cid:14)(cid:7)q(cid:7)(cid:27)1(cid:25)(cid:20)(cid:9)(cid:19)(cid:7):J]](cid:18)(cid:26)(cid:7)#(cid:13)(cid:2)(cid:10)(cid:3)(cid:11)(cid:5)(cid:4)(cid:7)(cid:20)(cid:11)(cid:5)(cid:7)(cid:29)(cid:3))(cid:30)(cid:13)(cid:4)(cid:23)(cid:5)(cid:6)(cid:7)!(cid:13)(cid:10)(cid:23)(cid:7) (cid:29)(cid:5)(cid:11)(cid:25)(cid:13)(cid:4)(cid:4)(cid:13)(cid:14)(cid:9)(cid:26) Figure 2. (cid:16)(cid:5)(cid:30)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:23)(cid:13)(cid:29)Q(cid:17)(cid:14)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:9)(cid:10)(cid:5)(cid:11)(cid:12)(cid:5)(cid:9)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:15)(cid:16)(cid:17)(cid:8)(cid:4)(cid:18)(cid:7)(cid:8)(cid:25)(cid:29)(cid:30)(cid:13)(cid:2)(cid:13)(cid:10)(cid:7)"(cid:4)(cid:4)(cid:14)(cid:2)(cid:13)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:7)$(cid:5)(cid:4)(cid:10)(cid:7)(cid:15)(cid:8)"$(cid:18)(cid:7)+(cid:14)(cid:9)(cid:2)(cid:5)(cid:29)(cid:10)(cid:7)+(cid:20)(cid:10)(cid:5)(cid:21)(cid:14)(cid:11)(cid:13)(cid:5)(cid:4)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)"(cid:10)(cid:10)(cid:11)(cid:13))(cid:3)(cid:10)(cid:5)(cid:4)(cid:26) SEQUENCE OF TASKS FOR RFIS IAT Note: $(cid:23)(cid:5)(cid:7)(cid:10)(cid:20))(cid:30)(cid:5)(cid:7)(cid:13)(cid:4)(cid:7))(cid:20)(cid:4)(cid:5)(cid:6)(cid:7)(cid:14)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:8)"$(cid:7)8(cid:21)(cid:3)(cid:11)(cid:5)(cid:7)(cid:29)(cid:3))(cid:30)(cid:13)(cid:4)(cid:23)(cid:5)(cid:6)(cid:7)(cid:13)(cid:9)(cid:7)2(cid:11)(cid:5)(cid:5)(cid:9)!(cid:20)(cid:30)(cid:6)(cid:19)(cid:7)6(cid:2)2(cid:23)(cid:5)(cid:5)(cid:19)(cid:7)q(cid:7)‘(cid:2)(cid:23)!(cid:20)(cid:11)(cid:10)~(cid:7)(cid:15):JJ](cid:18)(cid:26)(cid:7)+(cid:20)(cid:10)(cid:5)(cid:21)(cid:14)(cid:11)(cid:13)(cid:5)(cid:4)(cid:7)(cid:22)(cid:14)(cid:11)(cid:7)(cid:10)(cid:20)(cid:11)(cid:21)(cid:5)(cid:10)Q(cid:2)(cid:14)(cid:9)(cid:2)(cid:5)(cid:29)(cid:10)(cid:7)(cid:6)(cid:13)(cid:4)(cid:2)(cid:11)(cid:13)(cid:25)(cid:13)(cid:9)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:4)(cid:7)(cid:20)(cid:11)(cid:5)(cid:7)(cid:20)(cid:4)(cid:4)(cid:13)(cid:21)(cid:9)(cid:5)(cid:6)(cid:7)(cid:20)(cid:7)(cid:11)(cid:13)(cid:21)(cid:23)(cid:10)(cid:7)(cid:14)(cid:11)(cid:7)(cid:30)(cid:5)(cid:22)(cid:10)(cid:7) (cid:11)(cid:5)(cid:4)(cid:29)(cid:14)(cid:9)(cid:4)(cid:5)(cid:19)(cid:7)(cid:13)(cid:9)(cid:6)(cid:13)(cid:2)(cid:20)(cid:10)(cid:5)(cid:6)(cid:7)).(cid:7)(cid:10)(cid:23)(cid:5)(cid:7))(cid:30)(cid:20)(cid:2)1(cid:7)(cid:2)(cid:13)(cid:11)(cid:2)(cid:30)(cid:5)(cid:4)(cid:7)(cid:13)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:10)(cid:23)(cid:13)(cid:11)(cid:6)(cid:7)(cid:11)(cid:14)!(cid:26)(cid:7)$(cid:23)(cid:5)(cid:4)(cid:5)(cid:7)(cid:20)(cid:11)(cid:5)(cid:7)(cid:2)(cid:14)(cid:25))(cid:13)(cid:9)(cid:5)(cid:6)(cid:7)(cid:13)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:10)(cid:23)(cid:13)(cid:11)(cid:6)(cid:7)(cid:4)(cid:10)(cid:5)(cid:29)(cid:7)(cid:20)(cid:9)(cid:6)(cid:7)(cid:10)(cid:23)(cid:5)(cid:9)(cid:7)(cid:11)(cid:5)(cid:2)(cid:14)(cid:25))(cid:13)(cid:9)(cid:5)(cid:6)(cid:7)(cid:13)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)8(cid:22)(cid:10)(cid:23)(cid:7)(cid:4)(cid:10)(cid:5)(cid:29)(cid:19)(cid:7)(cid:20)(cid:22)(cid:10)(cid:5)(cid:11)(cid:7)(cid:11)(cid:5)(cid:12)(cid:5)(cid:11)(cid:4)(cid:13)(cid:9)(cid:21)(cid:7)(cid:11)(cid:5)(cid:4)(cid:29)(cid:14)(cid:9)(cid:4)(cid:5)(cid:7)(cid:20)(cid:4)(cid:4)(cid:13)(cid:21)(cid:9)(cid:25)(cid:5)(cid:9)(cid:10)(cid:4)(cid:7) (cid:15)(cid:13)(cid:9)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:22)(cid:14)(cid:3)(cid:11)(cid:10)(cid:23)(cid:7)(cid:4)(cid:10)(cid:5)(cid:29)(cid:18)(cid:7)(cid:22)(cid:14)(cid:11)(cid:7)(cid:10)(cid:23)(cid:5)(cid:7)(cid:10)(cid:20)(cid:11)(cid:21)(cid:5)(cid:10)Q(cid:2)(cid:14)(cid:9)(cid:2)(cid:5)(cid:29)(cid:10)(cid:7)(cid:6)(cid:13)(cid:4)(cid:2)(cid:11)(cid:13)(cid:25)(cid:13)(cid:9)(cid:20)(cid:10)(cid:13)(cid:14)(cid:9)(cid:26)(cid:7)(cid:7)+(cid:14)(cid:11)(cid:11)(cid:5)(cid:2)(cid:10)(cid:7)(cid:11)(cid:5)(cid:4)(cid:29)(cid:14)(cid:9)(cid:4)(cid:5)(cid:4)(cid:7)(cid:20)(cid:11)(cid:5)(cid:7)(cid:13)(cid:9)(cid:6)(cid:13)(cid:2)(cid:20)(cid:10)(cid:5)(cid:6)(cid:7)(cid:20)(cid:4)(cid:7)(cid:14)(cid:29)(cid:5)(cid:9)(cid:7)(cid:2)(cid:13)(cid:11)(cid:2)(cid:30)(cid:5)(cid:4)(cid:26) Figure 3. 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ERIC EJ983091: Therapists' Attitudes about and Preferences to Use Relationship Focused Interventions: New Tools to Measure a Critical Component of Functional Analytic Psychotherapy (FAP) PDF

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